Claims Specialist
Tacoma, WA Patient Accounts
Job Type
Full-time
Description

PUYALLUP TRIBAL HEALTH AUTHORITY, located in Tacoma, Washington is seeking a Claims Specialist.


“It is the mission of the Puyallup Tribal Health Authority to provide quality healthcare and promote wellness in a culturally appropriate manner.”


We offer an outstanding workplace, competitive market based salary, and benefits packages including:

  • Monday – Friday schedule
  • Medical/Dental/Vision benefits – monthly premiums paid 100% for employees
  • 18+ annual paid holidays
  • Generous paid sick and vacation accruals
  • 401(k) with annual profit sharing
  • Life & AD&D insurance coverage
  • PTHA is an approved loan repayment site for various programs
  • Employee Assistance Program
  • Excellent work/home life balance

GENERAL FUNCTION: Provide assistance to PTHA patients in gaining access to health care services and eligibility for Referral Services coverage. Process receipts and disbursements for contracted services.


ESSENTIAL FUNCTIONS:

  • Ensures that all IHS and Supplemental eligibility requirements are met prior to releasing claims for payment with 100% accuracy. Interpret alternate resource requirements and explain to health care providers and patients.
  • Explain various programs, policies and procedures to patients such as and not limited to: Supplemental policy, contract care policy, referral policy, exclusion lists and other various organizational policies.
  • Works closely with the referral services and Patient Access Team in collaboration to ensure the proper policies and procedures are followed.
  • Ensures that all alternate resources have been exhausted for client before payment is authorized with 100% accuracy.
  • Assist other Patient Accounts staff with claims as needed to minimize backlog.
  • Review, document, adjudicate and process claims pursuant to established policy and procedures, with 100% accuracy.
  • Research unpaid bills received from patients and providers. Review no Check List received from Third Party Administrator monthly.
  • Review, process, research and document pended claims for eligibility, authorization of third party coverage and payment/denial determination, with 100% accuracy.
Requirements
  • High School Diploma or GED. 
  • Two (2) years’ administrative/customer service experience in a health care setting.
  • Experience and/or ability to work with an Electronic Health System.
  • Must have good computer skills and proficiency in MS Office products (Word, Excel, Outlook, etc.).
  • Application and utilization knowledge of: private insurance plans, state Medicaid programs and Medicare.
  • Demonstrable knowledge of claims processing to include coordination of benefits, understanding of CPT and ICD-10 coding, medical and dental terminology.
Salary Description
$25.00 - $27.00